Provider Demographics
NPI:1528845096
Name:LAVERGNE, MIRA JEAN
Entity type:Individual
Prefix:MS
First Name:MIRA
Middle Name:JEAN
Last Name:LAVERGNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 DOC PREJEAN ST
Mailing Address - Street 2:
Mailing Address - City:SCOTT
Mailing Address - State:LA
Mailing Address - Zip Code:70583-5133
Mailing Address - Country:US
Mailing Address - Phone:337-581-2329
Mailing Address - Fax:
Practice Address - Street 1:921 DOC PREJEAN ST
Practice Address - Street 2:
Practice Address - City:SCOTT
Practice Address - State:LA
Practice Address - Zip Code:70583-5133
Practice Address - Country:US
Practice Address - Phone:337-581-2329
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker